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NR603 Week 1 Assignment, Comparison and Contrast Assignment: Migraines and Post-Concussive Syndrome
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NR603 Week 1 Assignment, Comparison and Contrast Assignment: Migraines and Post-Concussive Syndrome
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NR603 Week 1 Assignment, Comparison and ContrastAssignment: Migraines and Post-Concussive Syndrome
You will research the two areas of content assigned to you and compare and contrast
them in discussion post. NOTE: A comparison and contrast assignment is not about
listing the info regarding each disease separately but rather looking at each disease
side by side and discussing the similarities and differences given the categories below.
Consider how each patient would actually present to the office. Consider how their
history would affect their diagnosis, etc. Evaluation of mastery is focused on the
student's ability to demonstrate specific understanding of how the diagnoses differ and
relate to one another. Address the following topics below in your own words:
Presentation
Pathophysiology
Assessment
Diagnosis
Treatment
Dr. Ameri and class,
Walker- Migraines and Tension headaches
Presentation:
Migraines in adults are of moderate to severe intensity, unilateral, and described as a throbbing
or pulsating sensation. The patient may complain of nausea, vomiting, an aura, and sensitivity to
light, noise, and/or smells. The patient may feel foggy after a migraine (Moriarty & Mallick-
Searle, 2016). Tension-type headaches is the common headache and usually doesn’t require
seeking medical attention. Tension-type headaches are of mild to moderate pain intensity,
bilateral, described as dull pain or pressure, and do not throb. These patients may suffer from
less than 15 headaches per month and they may last anywhere from 30 minutes to 7 days.
Tension-type headaches are not aggravated by physical activity unlike migraines. Patients with
tension-type headaches won’t have symptoms of nausea or vomiting. Tension-type headaches
may cause a sensitivity to light or noise but not both (Rizzoli & Mullally, 2018). In all reality,
migraines are associated with more severe pain, may be debilitating, and may require medical
management to improve quality of life (Moriarty & Mallick-Searle, 2016).
Pathophysiology:
Migraines are a multi-factorial, recurrent, and hereditary headache disorder. Migraines may
have prodromes or auras that exhibit several hours before the migraine occurs (Burstein, Noseda,
& Borsook, 2015). Auras are correlated to four different aspects of the brain: hypothalamus,
brainstem, cortex, or limbic system. It is believed that migraines begin in areas of the brain
, capable of initiating an aura, but the headache occurs from the consequential activation of
meningeal nociceptors (Burstein et al., 2015). Tension-type headaches are associated with an
activation of nociceptors too, but the pain receptors are located in the pericranial myofascial
tissues. Muscular pain tends to be dull, achy, and poorly localized which is often times how
tension-type headaches feel to patients. Studies have shown that patients with an increased
sensitivity to stimuli (even harmless stimuli) in the pericranial myofascial tissues are likely to
exhibit more frequent tension-type headaches (Hanier & Matheson, 2013). Migraines and
tension-type headaches are similar in the fact that the activation of nociceptors cause pain but the
location of these pain receptors differ in location and cause different intensities of pain.
Assessment:
The writer would perform a neurological examination for both cases; however, it is easy to
distinguish between a migraine or tension headache based on the patient’s presentation.
Obtaining a proper history including onset, location, duration, characteristics, aggravating,
relieving, treatment, and severity. The provider should ask when the headaches first began, if
any trauma has occurred, and family history of migraines. It is important to ask about mental
health, sleep disorders, current medications the patient is taking, and social history (Weatherall,
2015). Observe how the patient walks including gait, posture, speed, symmetry, and coordination
when getting on the exam table. Assess the patient’s speech, use of language, and facial
symmetry. Assess the patient’s mental status. Perform an examination on cranial nerves I-XII.
Assess the motor system of the upper and lower extremities with active range of motion with and
without resistance for signs of weakness or differences of strengths. Assess for sensation of the
face and all four extremities (Buttaro, Trybulski, Polar-Bailey, & Sandburg-Cook, 2017).
Serious exam findings may include: new onset of headache after the age of 50, personality
change, papilledema, decreased deep tendon reflexes, painful temporal arteries, asymmetry of
pupillary responses (Buttaro, Trybulski, Polgar-Bailey, & Sandburg-Cook, 2017).
Diagnosis:
The diagnosis of migraines and tension-type headaches are made upon presentation without lab
or imaging. The International Classification of Headache Disorders (ICHD) is a tool utilized to
diagnose between different types of headaches. Patients with migraines have to have at least 5
attacks that last anywhere from 4 to 72 hours and had a least two of the four characteristics:
unilateral location, pulsating quality, moderate to severe pain, and/or aggravated by routine
physical activity. The patient will also complain of nausea, vomiting, or sensitivity to light
and/or noise (Weatherall, 2015). Tension-type headaches are diagnosed based upon the ICHD
and the patient may have a headache occurring on 1 to less than 15 days per month with mild to
moderate severity, non-pulsating, and the headache is not aggravated by physical activity
(Weatherall, 2015). The difference between the two headaches is based upon subjective data
retrieved from the patient and the use of the ICHD will assist the provider to diagnose the
condition. Imaging may be warranted if papilledema is seen on fundoscopy, new onset of
seizures, changes in memory or coordination, or if the patient has a history of cancer
(Weatherall, 2015).
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